1. Field of the Invention
The present invention relates generally to the field of tracheal intubation. More specifically, the present invention discloses a method and apparatus for intubating a patient with an endotracheal tube that uses a curved guide and a flexible light wand to ensure proper placement of the endotracheal tube.
2. Statement of the Problem
Endotracheal tubes are used in semi-emergency situations to ventilate patients with respiratory failure who may be conscious or semi-conscious. The conventional approach requires the patient to lie still while the physician inserts a rigid laryngoscope blade into the patient's mouth and trachea. Delivery of ventilation and/or oxygen is also interrupted during this period. The endotracheal tube is then inserted into place while the laryngoscope blade keeps the patient's airway open. Successful intubation depends on the patient being cooperative and completely relaxed, which unfortunately is often not the case. Even with a cooperative patient, intubation is very uncomfortable and can cause the patient to panic due to the difficulty in breathing during the procedure. This procedure can also result in a choking or gagging response that can cause the patient to regurgitate and aspirate contents from the stomach. One conventional response to these shortcomings has been to sedate the patient during intubation. Tranquilizers make the patient more cooperative and less likely to choke during intubation, but also tend to suppress the patient's breathing and blood pressure. These side effects may be unacceptable when dealing with a patient who already suffers from shallow or irregular breathing or depressed blood pressure. Therefore, a need exists for an improved device to guide insertion of an endotracheal tube and ensure the patient's airway is open, and that also allows the patient to continue to receive air/oxygen during the insertion process.
In addition, a separate but related problem exists because of the difficulty in advancing the distal end of the endotracheal tube through the patient's larynx and into the appropriate position in the trachea. The tissues of the larynx and trachea can be easily traumatized by the endotracheal tube or insertion guide. One common approach to this problem has been to insert a endoscopic probe through the endotracheal tube, and then advance both the endoscopic probe and endotracheal tube along the patient's airway. The healthcare provider can view through the endoscope and control the direction of the distal tip of the endoscope probe to guide the endotracheal tube into proper position. However, an endoscope typically costs several thousand dollars. In addition, the endoscope probe is relatively delicate and can be difficult to sterilize after use.
The prior art in this field includes several devices that use a light source on distal end of a wand to indicate the location of the distal end of the endotracheal tube. The tissue on the anterior side of the trachea below the larynx is relatively thin. If a small light source is placed adjacent to the anterior wall of the trachea below the larynx, it can typically be seen by the healthcare provider as a faint glow emanating through the anterior tracheal wall. Although an endoscope has the advantage of enabling the healthcare provider to guide and view the intubation process, the price of a light wand is a small fraction of that of an endoscope. In fact, a light wand can be made to be disposable. A light wand also has the advantages of being small, lighter, and easier to store in situations were space is limited, such as in an ambulance.
Laerdal Medical Corporation of Armonk, N.Y., markets the “Trachlight” light wand. This device has a removable metal stylet that is inserted into a flexible light wand and then bent into the general shape of a hockey stick. The light wand assembly is then inserted into an endotracheal tube, and both are advanced along the patient's airway to a position above the larynx. To minimize the risk of injury to the larynx, the stylet is then withdrawn from within the light wand. The distal ends of the endotracheal tube and light wand are then advanced through the larynx and into the trachea without the structural support of the stylet. The light source at the end of the light wand becomes visible to the healthcare provider by transillumination of the trachea when the light wand and endotracheal tube are advanced to the appropriate positions in the trachea.
A light wand is also currently marketed by Vital Signs, Inc. having a non-removable stylet. Here again, there is a risk that the rigid light wand or endotracheal tube will injure the larynx or trachea.
3. Solution to the Problem
None of the prior art discussed above show a flexible light wand to ensure proper placement of the distal end of the endotracheal tube, in combination with a curved guide that serves both to ventilate the patient and guide the endotracheal tube and light wand along the patient's airway and through the larynx. The present invention enables the patient to be ventilated during the intubation process. In addition, the curved guide eliminates the need for rigidity of the light wand and thereby reduces the risk of injury to the larynx or trachea.